Toro-Huamanchumo Carlos J, Hilario-Gomez Maryori M, Diaz-Reyes Nelson, Caballero-Alvarado José A, Barboza Joshuan J
Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad César Vallejo, Trujillo 13007, Peru.
Sociedad Científica de San Fernando, Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima 15081, Peru.
Children (Basel). 2022 Apr 21;9(5):589. doi: 10.3390/children9050589.
In neonates with meconium aspiration syndrome (MAS), continuous positive airway pressure (CPAP) may be more beneficial compared to endotracheal intubation (ETI). We evaluated the efficacy of CPAP in neonates with MAS.
Four engines were used to search randomized clinical trials (RCTs). We used relative risk (RR) and mean difference (MD) with 95% confidence intervals (95%CI) to assess the effect on dichotomous and continuous outcomes, respectively. In addition, we used the Paule-Mandel (PM) random effects model due to the anticipated lack of events.
Three RCTs were included ( = 432). No significant difference was found in mortality (RR = 0.82; 95%CI = 0.54-1.25; I = 71%; = 0.36), need for ventilation (RR = 0.49; 95%CI = 0.15-1.56; I = 71%; = 0.57), and incidence of pneumothorax (RR = 1.24; 95%CI = 0.30-5.12; I = 0%; = 0.77) in the CPAP group compared to the ETI group. Regarding secondary outcomes, compared to the ETI group, no significant differences were found in APGAR at one minute (MD = -1.01; 95%CI -2.97 to 0.94; I = 98%; = 0.31), APGAR at 5 min (MD = -1.00; 95%CI = -2.96 to 0.95; I = 99%; = 0.32), days of hospitalization (MD = -0.52; 95%CI = -1.46 to 0.42; I = 94%; = 0.28), and cord pH (MD = 0.003; 95%CI = -0.01 to 0.02; I = 0%; = 0.79).
In patients with MAS, there is no significant effect of CPAP use compared to ETI on primary, specifically on mortality, need for ventilation, the incidence of pneumothorax, and secondary outcomes.
在患有胎粪吸入综合征（MAS）的新生儿中，持续气道正压通气（CPAP）可能比气管插管（ETI）更有益。我们评估了CPAP对患有MAS的新生儿的疗效。
使用四个引擎搜索随机临床试验（RCT）。我们分别使用相对风险（RR）和平均差（MD）以及95%置信区间（95%CI）来评估对二分法和连续结果的影响。此外，由于预期事件数量不足，我们使用了Paule-Mandel（PM）随机效应模型。
纳入了三项RCT（n = 432）。与ETI组相比，CPAP组在死亡率（RR = 0.82；95%CI = 0.54 - 1.25；I² = 71%；P = 0.36）、通气需求（RR = 0.49；95%CI = 0.15 - 1.56；I² = 71%；P = 0.57）和气胸发生率（RR = 1.24；95%CI = 0.30 - 5.12；I² = 0%；P = 0.77）方面未发现显著差异。关于次要结果，与ETI组相比，在1分钟时的阿氏评分（MD = -1.01；95%CI -2.97至0.94；I² = 98%；P = 0.31）、5分钟时的阿氏评分（MD = -1.00；95%CI = -2.96至0.95；I² = 99%；P = 0.32）、住院天数（MD = -0.52；95%CI = -1.46至0.42；I² = 94%；P = 0.28）和脐血pH值（MD = 0.003；95%CI = -0.01至0.02；I² = 0%；P = 0.79）方面未发现显著差异。
在患有MAS的患者中，与ETI相比，使用CPAP对主要结局，特别是死亡率、通气需求、气胸发生率和次要结局没有显著影响。
